From an Art to a Science of Psychoanalysis
The Metapsychological Formulation Method
Background
The experience began with the idea that a clinical researcher would need to work with objectively-perceived patient “material” processed by the use of his(her) conscious, cognitive-emotional processes. It was at odds with much of what he was being taught about the formulation of patient/client “material” by the use of countertransferences and other forms of subjective experience, but, its logic being sound, it persisted. Then the “metapsychology” theory he was learning threw light on a conceptual problem posed by the latter methods. When transferences were metapsychologically dissected, they emerged as symptoms of still-active conflicts with inferable unconscious roots. And that meant that their effects on consciousness could neither be known nor influenced without lengthy work on the factors maintaining the need for a repression defense.
That then led to an interest in the concepts and principles of the various analytic “schools” (including the “classical” and its “metapsychology”) that had become part of his training. Were the concepts definable, identifiable (in the analysand’s concrete session efforts) and standardizable? And had the principles been scientifically developed and tested, i.e. derived from objective perceptions of unexplained symptom phenomena, subjected to tests of predictive capability, retested many times? And when the histories of theoretical development in both areas were not confirming, he set out to do his own studies in the clinical material of his analysands and those encountered during a self analysis of symptoms that had remained after his training analysis ended. Then as each success moved naturally to a next and continued onwards, the reliable theory to be summarized here became available for use in and out of the clinical situation.
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Chapter Summary
Part I: Symptoms at the Start of Consultation and Tools Needed for Their Formulation
1: The Symptoms of the Clinical Situation and the Framework Required for Their Identification: Two symptom categories are described in earlier (non-DSM) terms, “Character Neuroses” and “Symptom Neuroses” (Phobic, Obsessive-compulsive, etc). Explicitly-stated realistic treatment goals and process elements become reference points by which symptomatic activity in patient or analyst can be identified.
2: The Development of Symptoms: How such symptoms develop is described in 13 diagrams, and terms are defined. A reverse finding of what has been commonly believed emerges – that the conflict roots of the symptom neuroses lie deeper to those responsible for character symptoms when both are present.
3: The Symptom-bearing Mind at the Start of Consultation: All consultees have immediate transferences to the consultant that they cannot recognize as such. They must be observed and addressed at once to prevent the development of a serious process complication called the Glover Effect. Several examples are provided.
4: Clinical Records and a Codification System: How the clinician can record complex formulations while monitoring the patient’s efforts is described and illustrated.
5: Surfaces and Layers: How to identify and address the surface part of a symptom’s complex structure (its only workable part) is described.
6: The First “ROT” Symptom: The first “Resistance of the Operative Transference” type, encountered in consultations and in need of immediate attention, is reviewed.
7: The “Follow-up” Technique: When the consultant describes the first “ROT” to the consultee, he and his input are incorporated by one or more surface transferences of the same type. How the phenomenon is identified, understood and addressed is described.
Part II: The Concepts and Principles of Part I Elaborated
8: The Superego and the Ego Ideal: These structures are parts of the consultee’s memory function. In them are caretaker objects of childhood, with character neuroses underpinned by conflicts and unmet needs. They reverse normal service roles and enforce compliance with “standard-judgement-repercussion” systems, then produce transferences in which the consultant is perceived as doing likewise. How such transferences are identified and addressed is described with examples.
9: The Defenses: The defenses employed by patients exist in metapsychological complexes called “defense systems”. Several traditionally-accepted types found in transferences are examined for validity, and those that survive are highlighted.
10: The Drives: Part 1, In General and “Libido”: This chapter introduces the subject.
11: The Drives: Part 2, The Aggressive Drive: This is one of the most extensive and important areas of original discovery that M.F. research has opened. A unique categorization of the drive’s categories and forms vastly improves the consultant’s ability to identify its types and draw inferences from them that point to effective interventions.
12: Transference: Part 1, The Single Transference: The concept is elaborated.
13: Transference: Part 2, The Multiple Transference (M.T.) Theory: Original research here describes extreme “meta” complexities in which several, non-materially represented but inferable transferences from different objects are in operation at the same time.
14: The Symptoms of the “Borderline Personality Disorder” and the M.T. Theory: The symptoms of this condition (all but one of which the author studied in detail) are reviewed in the light of this theory, and that contributes to an understanding of their roots.
15: The Cure of Symptoms by the M.F. Method: The process is described in terms of: (1) Preparations before consultation; (2) Consultation phase; (3) Treatment process in 13 phases that include an ending determined by the analysand who has reached and dismantled conflicts at bedrock levels and become symptom-free.
16: Courage, Heroism and Rescue in the Practice of Psychoanalysis: This chapter addresses a little-studied area of analytic theory in which these analyst capacities are not symptoms but realistic requirements if analyses at certain stages are to remain viable.
Part III: Other Applications of the M.F. Method
17: Self Analysis: The possibility of systematic work that proceeds from an initial workable surface to the next, and the author’s personal experience with such, are described.
18: Clinical Research: This is a key area of M.F experience that has corrected the mistaken assumption that genuine scientific research (e.g. testing multiple hypotheses for predictive capability) in the clinical situation is impossible.
19: Understanding and Counteracting Destructive Aggression in the World at Large: This chapter addresses the problem of healthy aggressive drive forms forced off course by internal objects. Transference work offered thousands of opportunities to study its destructive effects and apply the theory created to a much-troubled broader world.
20: The Unconscious Sources of Art: As analysands are released from the repression defense, artistic creative abilities can be released as well. The author’s experience in this regard opened an unsuspected window into theory in this area and it is described.
21: M.F. Research and the Future: A next goal for future M.F. researchers will be to identify the factors responsible for the extreme lengths of conducted analyses and determine if they are essential. The author has observed some in which theoretically-informed analysands took much more time with conflicts similar to those he dismantled at root levels in his self analysis. Some aspects of the “length” problem in general are described here, but a complete answer to the disparity he has discovered is not yet among them.